Volume overload is common in patients with kidney failure initiating peritoneal dialysis (PD), and it carries serious risks, according to a new study published online ahead of print in the Clinical Journal of the American Society of Nephrology.

In the IPOD-PD study, 1054 patients with end-stage renal disease at 135 centers in 28 countries had volume overload of 1.9 L prior to starting PD, Wim Van Biesen, MD, PhD, Ghent University Hospital in Belgium, and his team reported. Within 1 year, volume decreased to 1.2 L, as measured by bioimpedance spectroscopy. Volume overload tended to improve by 6 months and stabilize.

Men and individuals with diabetes had higher risks for volume overload at any time point. Diabetes patients have more upregulation of vasopressin following hyperglycemia, according to the investigators.

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Volume overload was linked with higher risk for early death. A relative volume overload of more than 17.3% in the first month, compared with lower overload, was independently associated with a 59% greater risk of death. Yet more patients transitioned from PD to hemodialysis or transplantation than died during 3 years of follow-up: 23% and 22%, respectively, vs 13% who died.

Investigators observed different practice patterns between regions with respect to proportion of patients on PD vs HD, type of PD, and prescription of hypertonic solutions.

“We intended to associate practices of peritoneal dialysis—use of hypertonic exchanges, use of automated peritoneal dialysis vs. continuous ambulatory peritoneal dialysis, use of icodextrin, and use of diuretics—with technique failure,” Dr Van Biesen stated in a news release from the American Society of Nephrology. “Our main finding is that the association between technique failure and fluid overload is dependent upon centre size and thus presumably experience within the treating centre.”

The study was sponsored by Fresenius Medical Care, the producer of the BCM® bioimpedance spectroscopy device.


Van Biesen W, Verger C, Heaf J, et al. Evolution over time of hydration status and PD related practice patterns in an incident peritoneal dialysis patient cohort. Clin J Am Soc Nephrol.

Study examines volume overload in patients initiating peritoneal dialysis (news release). American Society of Nephrology; May 17, 2019.